Successful Treatment ofMycobacterium celatumPulmonary Disease in an Immunocompetent Patient Using Antimicobacterial Chemotherapy and Combined Pulmonary Resection

Abstract

Mycobacterium celatum is a nontuberculous mycobacterium that rarely causes pulmonary disease in immunocompetent subjects. We describe the successful treatment of M. celatum lung disease with antimicobacterial chemotherapy and combined pulmonary resection. A 33-year-old woman was referred to our hospital with a 3-month history of a productive cough. Her medical history included pulmonary tuberculosis 14 years earlier. Her chest X-ray revealed a large cavitary lesion in the left upper lobe. The sputum smear was positive for acid-fast bacilli, and M. celatum was subsequently identified in more than three sputum cultures, using molecular methods. After 1 year of therapy with clarithromycin, ethambutol, and ciprofloxacin, the patient underwent a pulmonary resection for a persistent cavitary lesion. The patient was considered cured after receiving 12 months of postoperative antimycobacterial chemotherapy. There has been no recurrence of disease for 18 months after treatment completion. In summary, M. celatum is an infrequent cause of potentially treatable pulmonary disease in immunocompetent subjects. Patients with M. celatum pulmonary disease who can tolerate resectional surgery might be considered for surgery, especially in cases of persistent cavitary lesions despite antimycobacterial chemotherapy.

Recommendations of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the Diagnosis and Treatment of Non-tuberculous Mycobacterioses

“…Since M. celatum rarely leads to pulmonary infection in immunocompetent patients, there is little experience with therapy. A Korean study described that a combination therapy including clarithromycin, EMB and ciprofloxacin was effective, followed by the resection of a persisting cavern [205].…”

Evaluation of Multidrug Therapy With Azithromycin, Rifampin, and Ethambutol for the Treatment ofMycobacterium aviumsubspaviumin Ring-neck Doves (Streptopelia risoria): An Uncontrolled Clinical Study

“…Similar protocols have been recommended for birds in the past 9,12,14,21 and are likely to be effective against mycobacterial species known to infect birds. 4, 26 We report the results of an uncontrolled clinical study undertaken to determine whether a recommended multidrug treatment regimen consisting of azithromycin, ethambutol, and rifampin administered orally 4,9,12,14,21,26 during a period of 6 months will eliminate infection from ring-neck doves (Streptopelia risoria) naturally infected with M avium subsp avium. We also sought to determine whether this treatment protocol would be free of adverse effects, if the mycobacteria would develop antibiotic resistance, and if a liver biopsy at the end of treatment, as has been previously reported, 14,27 could be used to assess treatment success.…”

A rare case of pulmonary mycobacteriosis caused by rifabutin resistant Mycobacterium celatum and review of the literature

“…In all described cases clarithromycin was used in a combination with one or two of these: ciprofloxacin, isoniazid, ethambutol and rifampicin. Pulmonary cavity resection was used successfully once as treatment for a pulmonary M. celatum infection [ 21 ]. Others have shown therapeutic success with antibiotic treatment only [ 22 , 23 ].…”